There are few population-based, prospective studies on the clinical course in patients with Crohn's disease.
Dr Magne Henriksen and colleagues from Norway extended the observation period in a population-based prospective study to find out more about the initial 5-year clinical course in Crohn's disease.
The research team related the findings to the Vienna classification.
The team assessed 843 patients diagnosed with inflammatory bowel disease between 1990 and 1993.
The patients were invited to a systematic follow-up visit at their local hospital 1 and 5 years after inclusion in the study.
The visits included a structured interview, a clinical examination, and colonoscopy.
|5-aminosalicylic acid was used in 54% of patients|
|Scandinavian Journal of Gastroenterology|
The researchers found that 200 patients with definite Crohn's disease were alive and had sufficient data for analysis 5 years after diagnosis.
The team observed changes in disease localization and behaviour in relation to the Vienna classification in 14%, and 18% of patients, respectively.
During the observation period, 28% of patients underwent surgery with intestinal resection, and half of these had disease localized in the terminal ileum.
At the time of the 5-year visit, oral sulfasalazin and 5-aminosalicylic acid were the most frequently used medications, used by 54% of patients.
The team noted that oral glucocorticosteroids and azathioprine were being used by 25% and 13%, respectively.
The researchers found that 72% of the patients had taken oral glucocorticosteroids at some time in the course of the 5-year period.
The majority of the patients had intestinal symptoms at 5 years, but only 16% had symptoms that interfered with everyday activities.
The team found that 14% of the patients had had a relapse-free 5-year course.
However, the researchers noted that relapse was not related to the initial Vienna classification.
When the patients described the clinical course, 44% reported an improvement in symptoms during the follow-up period.
Dr Henriksen's team concluded, “The 5-year clinical course in an unselected cohort of Crohn's disease patients was mostly mild.”
“The frequency of surgery was lower than that observed in other studies.”
“Only a minority of the patients had symptoms that interfered with everyday activities 5 years after the initial diagnosis.”
“The Vienna classification predicted the risk of surgery, but did not predict symptoms at 5 years, relapses during the observation period or the course of disease as described by the patients “